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Journal of Gastrointestinal Surgery

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01-09-2012 | Original Article

Influence of Neoadjuvant Radiotherapy on Anastomotic Leak After Restorative Resection for Rectal Cancer

Authors: Pasha J. Nisar, Ian C. Lavery, Ravi P. Kiran

Published in: Journal of Gastrointestinal Surgery | Issue 9/2012

Abstract

Purpose

This study was undertaken to determine whether neoadjuvant radiotherapy is associated with an increased risk of anastomotic leak for rectal cancer patients undergoing restorative resection.

Methods

From 1980 to 2010, patients who underwent restorative resection for rectal cancer (tumors within 15 cm of anal verge) were identified from a prospective institutional database and grouped based on whether they received neoadjuvant radiotherapy (+RT) or not (−RT). The main outcome was anastomotic leak documented by imaging (contrast leak), intra-operative or clinical (signs of peritonitis) findings and confirmed by staff surgeon assessment. Using multivariate (MV) analysis risk factors for leak were identified, presented as OR (95 % CI).

Results

One thousand eight hundred sixty-two patients were included in the analysis, 28 % in the +RT group. Eighty-six percent of +RT patients received neoadjuvant chemoradiotherapy. The overall leak rate was 6.3 %, with no significant difference in +RT and −RT groups (8 % vs 5.7 %, p = 0.06). The +RT group had a lower mean age at surgery (58 vs 63 year, p < 0.001), more male (75 % vs 62 %, p < 0.001) and more ASA 3/4 (44 % vs 35 %, p < 0.001) patients, greater use of defunctioning ostomy (87 % vs 44 %, p < 0.001) and colo-anal anastomosis (77 % vs 34 %, p < 0.001). Mean tumor distance from the anal verge was lower in +RT group (6.6 vs 9.7 cm, p < 0.001). On MV analysis, male sex (OR 1.64 (1.03–2.62), p = 0.038), ASA 4 (OR 4.70 (2.07–10.7), p < 0.001), tumor distance from anal verge ≤ 5 cm (OR 2.49 (1.37–4.52), p = 0.003), and tumor size at surgery ≥ 4 cm (OR 1.75 (1.15–2.65), p = 0.009) were independently associated with leak. +RT was not independently associated with leak (OR 1.44 (0.85–2.46), p = 0.18), while defunctioning ostomy did not reduce leak occurrence (OR 0.75 (0.44–1.28), p = 0.29).

Conclusions

The findings suggest that neoadjuvant radiotherapy is not independently associated with an anastomotic leak for rectal cancer patients undergoing restorative resection and support a selective policy towards the use of a defunctioning ostomy on a case by case basis based on intra-operative judgment and consideration of tumor location, size, and patient characteristics.

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Title: Influence of Neoadjuvant Radiotherapy on Anastomotic Leak After Restorative Resection for Rectal Cancer
Authors: Pasha J. Nisar
Ian C. Lavery
Ravi P. Kiran
Publication date: 01-09-2012
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 9/2012
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-012-1936-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Influence of Neoadjuvant Radiotherapy on Anastomotic Leak After Restorative Resection for Rectal Cancer

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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